Reply To: Week 3 Homework Assignment (Ethical Issues in Clinical Supervision)

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1. Parties impacted
John (the supervisee), Steve (the supervisor), their satellite agency peer team, their families, John’s clients, the larger agency administrative staff including Steve’s clinical supervisor of his supervision.

2. Ethical Issues
There are multiple boundary issues that Steve and John are dealing with in this situation. Steve worked to minimize these possible pitfalls in discussing their dual relationship up front within their new relationship. It may have also been helpful to advocate for supervising in another office to minimize dual relationships.
Doing no harm to the client is another important ethical consideration. John’s heavy caseload seems to be increasing his stress responses to his clients and others around him.
Self-care is another ethical consideration when looking at John’s high risk of vicarious traumatization leading to relapse. All parties may be impacted by his unhealthy self-care choices. Steve may also be struggling with self-care due to his dual relationship.

3&4. Viable courses of action, include benefits and risks
a. Meet with John to address his client load/stress issues and caseload management.
Benefits for John: helps him address work stress and possibly move toward his own self-care.
Risk for John: has to be self-motivated, doesn’t address relapse and therefore may affect friendship and further clinical work.
Benefits for Steve: helps his supervisee, avoids difficult conversation
Risks for Steve: avoiding issue reinforces maladaptive coping skills from Co-occurring patterns, no accountability for John’s actions, risk of Steve’s own professionalism and job if John continues drinking.
Benefits/risks for the clients/agency: continued compromised clinical care and legality issues.
b. Meet with John to address his relapse at work, including creating a restorative, corrective plan including being transparent about agency rules. Plan includes consequences of continuing behavior.
Benefits to John: clarity about agency regulations, supportive plan
Risks to John: no focus on the increased stressors or other personal self-care, may feel friendship is compromised.
Benefits to Steve: clarity about agency regulations
Risks to Steve: may feel punitive, compromised friendship, feeling torn about his dual roles. Client care may also be compromised in the long run if John’s client care is not addressed.
c. Hold John’s confidence while increasing support for his heavy load and plan for self-care.
Benefits for John: gives him another chance to get back on track personally, preserves the friendship, helps support his work stress for restoration.
Risk for John: at higher risk toward getting fired due to not knowing the agencies guidelines, easier to hide problem and not address root causes.
Benefits for Steve: hopeful to preserve friendship and still help him as a supervisee.
Risks for Steve: torn between friendship and clinical obligations
Risks for the clients/agency: compromised clinical care and legality issues.
d. Steve transfers to another satellite agency
Risks for John: continued risk of relapse, compromised clinical care and possible consequences in the future
Benefits for Steve: avoidance of losing his friendship, decreased further dual relationships
Risk for Steve: decrease in self-efficacy for not addressing the issue directly, decreased confidence from co-workers and within the agency.
e. Fire John directly.
Multiple Risks for all parties including client and co-worker loss of a clinician/team member, loss of friendship, unethical treatment of an employee, agency not supporting John in his recovery, as is their mission as a co-occurring treatment center, etc.

5. Consultation and why?
It is good that Steve consulted within agency, due to their specialty. Consultation can help Steve determine his professional plan of action to support John’s clients AND John, but also to help himself balance his own self-care and recovery progress.

6. Best possible course of action
I would say a combination of a and b above. Steve can meet with the client to address all issues: compromised clinical care, supervisee’s compromised self-care and relapse, a plan of corrective action and clear consequences if these are not addressed. Steve would continue supervision of supervision (or consultation) to manage his own professional ethical work with this supervisee as well as his own self-care.

7. Implementation, documentation of the decision making process and monitor/evaluate effects of the decision?
Implementation of the meeting is done with immediacy. Steve will communicate his concern for John professionally and personally. Focus of the supervision will be on John’s self-care, management of his caseload and restorative planning for ethical, clinical client care. Steve will be upfront with John about documenting this supervision as well as having John sign any restorative plan created in the meeting. The plan will also include the awareness of possible consequences if John continues to drink at work. Self-care planning will be discussed and may include Steve discussing possible further supportive referrals for John (AA meetings, his own counseling, etc.) Steve may offer to increase supervision to weekly for a short period of time (agency work can be group focused, bi-weekly or monthly) to make sure John feels supported in his work at the agency. All actions will be documented.
Steve may also bring up their dual relationship again, stressing supports and also being clear about boundaries.
Steve may decide to increase his own supervision of supervision for his own self-care, as well as his own outside supports.